Mouthing, which involves placing non-food objects into the mouth, is a common behavior seen in individuals with Autism Spectrum Disorder (ASD). While this behavior is typical in early childhood, its persistence beyond the toddler years often serves as self-regulation or sensory seeking. When this oral seeking behavior involves the compulsive ingestion of inedible substances, it is clinically termed Pica, which carries significant health and safety concerns. Managing this behavior safely requires understanding its underlying reasons and redirecting the need for oral input into appropriate, controlled alternatives.
Identifying the Function of the Behavior
Effectively addressing mouthing requires determining its function, or the “why,” behind the behavior through careful observation and analysis. The most common function is sensory regulation, where the individual seeks intense input to the mouth, jaw, or tongue to help their nervous system feel more balanced. This can manifest as seeking deep pressure, specific textures, or particular tastes that non-food objects provide.
The behavior can also function as a self-soothing mechanism in response to anxiety, stress, or under-stimulation due to boredom. Mouthing acts as a repetitive, predictable action that helps calm the nervous system during periods of emotional dysregulation. Keeping a detailed log of when the behavior occurs, such as during transitions, quiet times, or high-demand activities, helps identify specific triggers.
A less frequent function is communication or attention seeking, especially for individuals with limited verbal skills. The behavior may communicate a need for a break or a feeling of discomfort, with the resulting adult response inadvertently reinforcing the action. Understanding whether the mouthing happens when the person is alone versus when they are around others is a helpful clue in this functional analysis.
Environmental Adjustments and Prevention Strategies
Proactive strategies focus on modifying the environment and schedule to reduce the likelihood of the behavior occurring. A foundational step is Stimulus Control, which involves removing non-approved, high-risk objects from the immediate environment. This means diligently childproofing the area by securing cabinets with cleaning agents, vacuuming small choking hazards daily, and ensuring common household objects are out of reach.
Creating a designated “safe zone” where only approved, non-toxic items are available helps establish clear boundaries. Consistent supervision is necessary to intervene before an object reaches the mouth, especially those posing a choking risk. This allows for immediate redirection to a safe alternative, preventing the inappropriate behavior from being completed.
Scheduling regular sensory breaks throughout the day is another powerful antecedent strategy. Incorporating activities that provide deep pressure or proprioceptive input, such as jumping, pushing, or pulling weighted objects, helps regulate the sensory system. Proactively offering this input can lessen the body’s need for self-regulation through mouthing.
When an individual approaches an inappropriate item, Redirection should be used immediately to guide their attention toward an acceptable alternative. This technique is most effective when paired with positive reinforcement, praising the individual for choosing the safe alternative. Visual supports, such as a chart of approved chewable items, can also teach the distinction between acceptable and non-acceptable objects.
Implementing Appropriate Sensory Alternatives
The most effective long-term strategy involves replacing the problematic behavior with a safe, acceptable action that serves the exact same sensory function. Chewelry, or chewable jewelry, is a popular tool made from non-toxic, medical-grade silicone. These items come in various shapes, resistance levels (soft, medium, firm), and textures, allowing the user to find a tool that matches the intensity of their oral seeking needs.
For individuals requiring more intense stimulation, specialized vibrating oral tools provide strong, localized sensory feedback. Tools like vibrating toothbrushes or textured hand-held devices can be used on the cheeks, gums, and tongue. This meets the need for deep pressure and vibration in a controlled manner, which is helpful for those seeking input associated with chewing hard objects.
Incorporating specific foods into a “sensory diet” can also satisfy oral cravings and provide appropriate jaw work. Intense proprioceptive input to the jaw muscles can be provided by:
- Chewy foods (e.g., dried fruits, jerky, bagels).
- Crunchy foods (e.g., raw carrots, apples, celery).
Drinking thick liquids, such as smoothies or applesauce, through a thin straw also creates resistance and provides a calming oral motor workout.
Functional Communication Training (FCT) teaches the individual to request a safe oral alternative or a break instead of mouthing. This involves teaching a clear, alternative signal, such as pointing to a picture of a chew tool or using a simple vocal request. Consistency in immediately providing the requested alternative reinforces the use of the new communication skill.
Monitoring Safety and Health Risks
The persistence of mouthing or Pica behavior carries numerous immediate and long-term health risks that necessitate careful monitoring. Immediate hazards include:
- Choking on small objects.
- Internal injuries, such as bowel perforations, from ingesting sharp items (e.g., glass, metal, or plastic).
- Intestinal blockages or obstructions from ingesting large or non-digestible items.
Long-term health concerns are serious and varied. These include the risk of poisoning from ingesting toxic materials like lead paint chips or cleaning agents. Chronic mouthing of dirty objects can also introduce parasites and bacterial infections. Excessive wear and tear on the teeth, including chipping, cracking, or damage to dental enamel, is a common consequence of chewing on hard objects.
Individuals engaging in Pica often have nutritional deficiencies, such as low iron or zinc levels, which may contribute to the craving. Regular medical and dental check-ups are necessary to address physical damage, rule out underlying medical issues, and monitor for deficiencies. For severe or persistent cases, a specialized professional, such as a Board Certified Behavior Analyst (BCBA), can conduct a thorough functional assessment to create a personalized, comprehensive intervention plan.